For tough cancer cases, advice from the cloud

Platform links doctors around the world

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Best Doctors is encouraging medical societies and physicians’ organizations to join Medting.

By Karen Weintraub
Globe Correspondent
March 28, 2014

In the cancer world, when doctors get stumped by a particular case, they often turn to colleagues for a group consult that’s known as a “tumor board.”

That expert input usually depends on having a group of specialists down the hall. But sometimes doctors want input from someone they don’t see every day, or they work in small hospitals, or lack a particular specialist on their team.

Now a Boston-based medical service is creating an online platform that can act like a virtual tumor board for physicians and specialists from all fields who want to ask for help or trade advice with peers from around the world. It is a group exercise that could lead to faster, more accurate diagnoses and treatment plans for patients.

“The more doctors you can share a difficult case with, the more apt we are to find more brain power around the world and the better off we’re going to be as patients, and that’s what this is all about,” said Eric Glazer, vice president of physician engagement and social media for Best Doctors, which is launching the online platform called Medting.

In its main business, Best Doctors, based on Federal Street, acts as a second opinion service, by offering diagnostic and treatment consultations from doctors who are tops in their fields. The company says it serves more than 30 million patients around the world, mostly through contracts with large employers; participating physicians are paid a fee for their advice.

The idea to create a platform for consults-in-the-cloud started in the United States with a group of blood cancer experts who are active in their trade group, the American Society for Blood and Marrow Transplantation, and who wanted a better way to offer one another advice on difficult bone-marrow cases. One of those physicians, who had consulted for Best Doctors, suggested the society use Medting as a place for the specialists to exchange input on cases. The idea blossomed from there.

“So far it’s been a resounding success,” said Dr. Miguel-Angel Perales, a member of the society and deputy chief of adult bone marrow transplant services at Memorial Sloan Kettering Cancer Center in New York.

Perales said more than 200 blood and bone marrow specialists have signed on to the collaboration and have so far reviewed some 30 to 40 cases together. Based on the experience of the bone marrow group, Best Doctors believes physicians in other fields would benefit from having a similar online exchange where vexing cases be discussed.

The company is encouraging other medical societies, physicians’ organizations, and health care nonprofits to subscribe to Medting and create platforms in their fields.

Glazer said Best Doctors hopes the service will go viral within a range of specialties, fostering collaborations and spreading knowledge. Best Doctors will not disclose terms but said the subscription fee will be modest, just enough to cover its cost of providing the service.

The protocol is straightforward. A doctor looking for help logs onto Medting and simply posts questions, as well as a description and relevant images, such as MRI scans of tumors. Peers respond whenever they have free time, offering advice and opinions.

Responses on Medting may come even faster than they do at a typical tumor board, Glazer said, because doctors can answer on their own time, rather than having to coordinate busy schedules for a sit-down meeting.

Perales cited one recent example in which a doctor sought help from the blood specialists about an older patient who could not get a marrow transplant until his leukemia was under control. Another doctor from the Mayo Clinic saw the posting and suggested the physician try a drug normally used to treat a different type of leukemia. The drug worked, Perales said, and the patient is now scheduled for a transplant, which could cure him.

Dr. Mark Litzow, a hematologist and bone marrow transplant specialist at the Mayo Clinic in Rochester, Minn., has access to some of the best doctors in the world right in his own building. But Mayo doctors can learn from colleagues elsewhere in the medical world, he said.

“Sometimes at the same institution, people tend to think in similar ways,” Litzow said. “If you can tap into someone’s brain who’s at a different institution or someone who thinks a little bit differently, it can be helpful. It’s like teaching: Sometimes you get as much or more out of it than the students do. It can refresh my thinking about a particular situation.”

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